Psychiatrically hospitalized adolescents (PHAs) are currently understudied and not targeted for HIV prevention efforts. They are at increased risk for HIV transmission because of high rates of unprotected intercourse, drug use, sexual abuse and prostitution. Psychopathology, family dysfunction and lack of resources probably make the risk even greater in this large and diverse group of adolescents. Our preliminary work with PHAs suggests that intervention is possible, although it needs to be carefully tailored. We will implement and evaluate the effectiveness of an HIV Prevention Program on the inpatient adolescent psychiatric units at Bradley Hospital, utilizing a pretest-posttest design with follow-up. Upon admission, we will assess the PHAs' high-risk sexual and drug-related behaviors, knowledge and attitudes about HIV, psychiatric diagnosis, distress, and style of functioning. In Phase I of the project, individual interviews and focus groups will assist in revising existing scales for use with PHAs and suggest specialized intervention strategies. In Phase II, PHAs between the ages of 13 and 18 will be randomly assigned to participation in an intensive HIV Program that will be based on our current work with skills building/decision making in normal adolescents. At discharge and at 3 and 6 months post-discharge, we will re-assess attitudes and risk-taking behaviors in adolescents from the intervention and control groups to determine the intervention's impact. Upon conclusion the project will have defined factors relevant to HIV preventative behaviors in PHAs. It will have demonstrated the effective elements of an HIV prevention program and will produce a curriculum/training guide for use in other psychiatric units.